Since Omicron first appeared here in December 2021, the United States has had a 63% higher COVID death rate than other high-income nations. We also continue to experience profound disparities by race and ethnicity in the risk of infection, hospitalization, and death from COVID. Although federal agencies issued guidelines on how to stay safe, it was our local and state responses that explain many of the differences in health outcomes.
We turned to researchers working with Systems for Action, Policy for Action, and Evidence for Action, all flagship research programs of the Robert Wood Johnson Foundation, to find evidence-based answers within policies, practices, and data that help explain these disparities. Questions included: What responses worked best during the pandemic for our general population and for communities most at risk? And how can we respond to future large-scale national emergencies in ways that better protect the health of vulnerable people and communities?
Here are three important lessons that emerged:
1. Pandemic response policies must protect those most at risk
While rapid policy responses to COVID (from physical distancing to temporary paid leave) were intended to protect the general public, many of these policies left out groups most vulnerable to the health and economic consequences of COVID -19. For example, the federal Families First Coronavirus Response Act excluded some 60 million workers, including health care providers and first responders who were unable to stay home or practice measures such as physical distancing.
Safety net programs like paid leave weren’t accessible to many temporary workers and part-timers, even after evidence showed low-income workers were more likely to contract COVID. When vaccines became available, the government prioritized age groups over risk, bypassing many people in essential industries who continued to work to keep the nation running while risking exposure to the coronavirus.
Julia Raifman is a researcher at the Boston University School of Public Health who helped develop a database to track state implementation of health and social policies in response to COVID. She notes: “It’s been really surprising to track these policies because we see that there are several that leave out lower-income informal sector workers time and time again: minimum wage policies, unemployment insurance policies, paid leave policies. and health insurance. We need to ensure that social support policies reach people who have part-time jobs or work as independent contractors, who are most likely to need support to avoid housing and food insecurity. We also need policies like a temporary OSHA (Occupational Safety and Health Administration) emergency standard that reaches all workers.”
2. Policymakers should take steps to expand and protect insurance coverage through Medicaid expansion and other measures
In what turned out to be the most significant test of the US health insurance system since the implementation of the Affordable Care Act, the pandemic and associated recession hit insurance coverage, making it harder to access to health care for people with low incomes. Rapid response research found that the presence of Medicaid expansion was associated with protective effects on coverage for Black and Latino populations during the rise in the uninsured rate.
“Medicaid has tremendous potential to protect people from economic shocks,” said study author Aditi Bhanja, who is a research adviser at the Women’s Refugee Commission. “While our study covered only four states, the data suggests that extending safety net benefits is beneficial to individuals and communities. As we will encounter emergencies in the future, it is important that we quickly assess how well our system can help the most vulnerable among us.”
3. Partnerships that improve care for people with complex needs are especially important during a pandemic
People living with complex medical, behavioral health and social needs require an integrated approach to care. An ongoing study is evaluating the effectiveness of California’s Whole Person Care (WPC) initiative that coordinates services for people receiving Medi-Cal. These pilots use diverse care coordination teams to help reduce silos, improve the value of care, and increase access to care, ultimately helping to improve the health and well-being of those who participate in the program. .
During the COVID-19 pandemic, the partnerships formed through WPC have remained strong. “Many staff members in WPC programs were public health workers who were reassigned to deal with urgent COVID response activities,” said evaluator Nadereh Pourat of the UCLA Center for Health Policy Research. “Still, they were able to use their experience and connections to provide important benefits to people in the program, like helping homeless people find housing quickly because they were already enrolled in the program. Create partnerships between county health agencies, other agencies and providers, and community organizations [now] It means you don’t have to start from scratch in public health emergencies.”
How politics can support healthy equity in the future
This evidence suggests that better policies and policy implementation can improve health. The COVID-19 pandemic has shown that this is an important time to reinstate policies that expand and support the tools that are most effective in controlling the spread of COVID, and to prioritize protections for people who have been left behind by too many emergency policies. the era of the pandemic. decisions
We know what works: more inclusive social policies that prioritize disproportionately affected communities, including racial and ethnic groups, as well as essential workers. We must extend benefits and expand safety net programs like Medicaid, especially for those facing health disparities. We must continue to build partnerships across sectors, agencies, programs, community groups, policymakers, and stakeholders, both to benefit ongoing public health efforts and to better prepare for future public health emergencies.
There is a treasure trove of rapid response policy research from the COVID era – let us rely on this evidence to address health inequalities during the pandemic and after it is over.
The COVID-19 pandemic revealed how racism has shaped the life course of Black and Latino communities.
LISTEN to my discussion with Dr. Alonzo Plow about his new book, Necessary Conversations, which examines racism as a barrier to health equity and offers strategies for building a healthier, more equitable future.
ABOUT THE AUTHOR
Jacquelynn OrrResearch-Evaluation-and-Learning program officer, is a strategic liaison for the Foundation’s efforts to transform health and health care systems.